August 29, 2017
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Lack of treatment in HBV leads to increased FIB-4 no matter viral load

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While patients with hepatitis B who received treatment had a significant initial decline in viral load and little to no change in FIB-4 score, patients with HBV who remained untreated had a gradual increase in FIB-4 score over time, including those who were immune inactive, and had little to no decrease in viral load, according to recently published data.

“Findings from several clinical trials have suggested that long-term viral suppression with antiviral therapy improves liver histology and may result in regression of fibrosis, especially in patients with more advanced liver disease,” the researchers wrote. “Using a bivariate modeling approach, we used [the Chronic Hepatitis Cohort Study (CHeCS)] data to evaluate the longitudinal evolution of viral load in both untreated and treated patients [with HBV], as well as two surrogate markers of liver fibrosis.”

The researchers accessed data from the CHeCS cohort on patients with HBV treated between January 2006 and December 2013. They analyzed 766 patients (59% men; 61% Asian American), including 342 untreated and 424 treated patients. Those treated received nucleos(t)ide analog therapy with or without interferon-based therapy (97%) or either interferon or pegylated interferon-based therapy (3%).

Researchers assess viral load and FIB-4 scores at less than 5 months, 5 to 28 months and more than 28 months. At index date, log10 viral load and log10 FIB-4 scores were lower in the untreated group than the treated group (P = .001).

Among the untreated patients, the viral load slope did not significantly change at 5 months, decreased slightly between 5 and 28 months (3.1% per month; P < .001), but did not significantly change further after 28 months. FIB-4 score did not significantly change up to 28 months, but increased after (0.9% per month; P < .001). The overall monthly percentage change of FIB-4 score in untreated patients was significantly higher than that of treated patients (P < .001) and researchers estimated it would double within 6.5 years in those who remain untreated regardless of initial score.

Treated patient’s viral loads decreased sharply over 5 months (31.8% per month; P < .001), between 5 and 28 months (1.7% per month; P < .004) and continued after 28 months (1.4% per month; P = .019). The monthly percentage change of viral load was significantly different from untreated patients for the first 5 months after the 28-month study period (P = .035). While there was no significant change to FIB-4 at 5 months, treated patients showed a decline between 5 and 28 months (0.5% per month; P < .001). There was no change past 28 months.

“In our treated patient sample, we observed that antiviral treatment results in a rapid decline in viral DNA load, findings that are consistent with results from clinical trials. Our data illustrate the timing of the decline in FIB4 that follows, suggesting a delayed but significant regression of liver fibrosis,” the researchers wrote. “In untreated patients, it has long been recognized that the fluctuating nature of chronic HBV infection necessitates careful surveillance; however, a recent study found that such surveillance is often inadequate. This may be cause for concern, as we observe that FIB4 increases in our untreated patient sample, suggesting fibrosis progression—even among the subset of patients who were not candidates for therapy based on current guidelines.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.